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December 01, 2021

Getting to the root of overworked and burned-out veterinary practices

AVMA economic forum makes sense of workforce woes
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Veterinary professionals are struggling.

For many, the dream job of caring for animals is feeling less and less dreamlike. Many veterinarians feel they are working more hours than ever before, meeting increased demand from their current clients, in workplaces with low morale and high staff turnover. Practices struggle to hire associates and veterinary technicians—roles essential to keeping the practice running.

“Practices and veterinary care teams are very busy, and burnout and stress are real issues that many people are going through,” said AVMA Chief Economist Matthew J. Salois, PhD. “We are in a very tight labor market, and it is very hard to recruit and retain talent right now—and no doubt contributing to a sense of burnout.”

Dr. Salois opened the AVMA Veterinary Business and Economic Forum, held virtually Oct. 14-16, by discussing the root causes behind the busyness and burnout assailing veterinary practices these days. His overall message is that there is a complex series of factors that must be understood if the profession is to effectively address the very real problems practices and veterinary professionals are experiencing.

“A very common story being told in our industry goes something like this: Demand for pets soared during the pandemic with epic levels of pet adoptions. Concurrently, veterinary practice has experienced a skyrocketing demand for services resulting in a crisis for the workforce as the supply of veterinarians and veterinary services was unable to meet demand.”

And while there’s “quite a bit of truth” in this view, Dr. Salois said, it is an oversimplification.

The reality, as Dr. Salois explained, is the so-called pandemic “pet adoption boom” is a bit of an exaggeration. While new clients are partly contributing to increased business, it is actually increased spending coupled with pent-up demand from current clients that makes up the bulk of growth in revenue and visits. This was confirmed in a later presentation by VetSuccess. And finally, inefficiencies and staff turnover, exacerbated by the COVID-19 pandemic, have escalated problems of packed schedules and staff burnout (see story).

“We have a very challenging workforce dilemma,” Dr. Salois said, “one that has significant ramifications to well-being and staff turnover.” And practices are feeling it.

Digging deeper into the data

A review of transactional data collected by 24PetWatch and Best Friends Animal Society indicates the total number of pets adopted from shelters in 2020 was the lowest in five years.

Shelters made a concerted effort to move animals out of the shelter and into foster care. Adoption processes were longer during the pandemic. Shifting adoption visits to virtual appointments and, later, to only allowing a limited number of physical visits meant that fewer pet adopters could be handled in a given week. And successful spay and neuter programs have also proven effective in keeping populations down.

“Simply put, fewer animals in the shelter meant fewer animals to adopt,” Dr. Salois explained.

Pet adoptions in 2021 so far look a lot like 2020, Dr. Salois added. Tracking data indicate adoptions are 1.6% below 2020, with cat adoptions outpacing dog adoptions. Compared with 2019, current adoptions are almost 20% lower. While shelters are not the only source of new pets, they remain a leading source in addition to pet stores and breeders (see story).

Why so busy?

Monthly clinical appointments per practice grew by 4.5% in 2020 on average and in 2021 are currently tracking 6.5% ahead of last year, which of course is positive news, Dr. Salois said, adding that it raises important questions: Is growth of 4.5% to 6.5% epic? This growth is healthy—and maybe even unprecedented—but is it enough in itself to send practices and staff into a tailspin? Is that alone enough to send our workforce into a state of crisis? Or are there additional factors at play?

Such queries aren’t intended to dismiss the reality of busy practices and exhausted veterinary professionals, Dr. Salois emphasized. Rather, it’s an acknowledgment of the real and tangible challenges veterinary practice teams are experiencing and—importantly—a way to better understand the root causes of these challenges so that the profession can implement strategies that will successfully alleviate the stress.

Dr. Salois explained that the spike in business isn’t a result of new patients. In fact, the average annual share of total appointments that are new patients has been declining the last few years, from 17.1% in 2019 to about 15.8% in 2021. What’s happening is practices are catching up with the backlog of appointments canceled or rescheduled as a consequence of the pandemic, along with current clients and pet owners paying more attention to veterinary care.

In addition, many problems can be traced to declining veterinary practice productivity and inefficiencies in practice operations, made worse during the coronavirus pandemic, Dr. Salois said. One measure of veterinary productivity is to look at the average number of patients seen per hour by a veterinarian. In 2020, U.S. veterinary practices saw a 25% decline in the average number of patients a veterinarian could see per hour.

With a 4.5% increase in appointments and a 25% decrease in the number of patients a veterinarian can see in an hour, those feelings of being overworked start to make sense, Dr. Salois said.

“Let me be very clear. This does not mean you are doing less work. It means the efficiency in which you are working has been hampered,” he explained. “It’s like running a mile on a treadmill versus running a mile on the beach. The distance is the same, but obviously one takes a lot more effort and maybe even more time. That means in order to see the same number of patients you did before COVID-19, now you have to work a lot harder, exert more effort, and maybe even work longer hours.”

Making matters worse is that a sizable and growing number of veterinarians actually would prefer to work fewer hours and would do so for a lower level of compensation (see story). There are also high rates of staff turnover. As Dr. Salois explained, the average veterinarian turnover rate is about 15-17%, which is twice that of a physician working in private practice, and the average veterinary technician turnover rate is over 25%, which is among the highest in a comparison of different health professions.

“Staff turnover is costly, time-consuming, and it further negatively impacts productivity,” Dr. Salois explained. “From an economist’s perspective, high turnover is a symptom of a larger issue.” Specifically, Dr. Salois expanded, it is a warning sign that veterinary professionals are feeling overworked and overstressed, which is one of the factors that can also affect the productivity of any organization.

What now?

Dr. Salois stressed throughout his presentation that an oversimplification of a problem can lead to oversimplified solutions.

It’s not enough to increase the size of the veterinary workforce by graduating more veterinarians or creating a new class of veterinary practitioner, what some have referred to as a midlevel practitioner or midlevel extender. Neither address the productivity gaps, nor do they remedy the high turnover rate.

“We don’t need a five-year plan, we need a right-now plan,” Dr. Salois said. “Like a patient who is bleeding out, you need blood, but the first priority has to be to stop the bleeding.”

There are several solution-oriented strategies that can help in the short-term, Dr. Salois explained, such as telemedicine and other technological innovations, better utilization of veterinary technicians, and creating a sense of purpose and belonging for all members of the animal care team.

“Taking action to leverage technology, empower talent, and engage the team are all things we can do right now,” Dr. Salois said.

The AVMA 2021 Economic State of the Veterinary Profession is now available. This latest report examines major trends in veterinary education, veterinary employment, and veterinary services.